Aims: To describe the clinical characteristics of ocular surface squamous neoplasia (OSSN) in a sub-Saharan referral hospital setting according to histopathological diagnosis and HIV status. Methods: All patients were enrolled who presented consecutively to the Kilimanjaro Christian Medical College eye department with lesions suspected to be OSSN from September 2005 to May 2007 and from February 2008 to September 2008. Clinical characteristics were documented on a standardised form, excision biopsies were performed and histopathological diagnosis was obtained on all cases. Data were analysed to look for associations among various factors. Results: 150 patients were enrolled. Histopathological study showed OSSN in 88% of cases. Of these, 128 (85.6%) were under the age of 50 years and 60% were HIV positive. The median CD4 cell count was 71 cells/μl among HIV-positive cases. Independent of size, the lesions of patients who were HIV positive were more likely to be higher grade malignancy than those who were HIV negative. Conclusion: In a sub-Saharan setting, OSSN occurs in persons who are younger than in industrialised countries and is often associated with HIV positivity. CD4 cell counts indicate that a majority of HIV-positive patients with OSSN are significantly immunosuppressed at presentation. Higher grade malignancy in this group could indicate a more aggressive course.

The International Nurses Association is pleased to welcome Mary Popp, RN, to their prestigious organization with her upcoming publication in the Worldwide Leaders In Healthcare. Mary Popp is a Registered Nurse working for MetroDerm, P.C. in Atlanta, Georgia. Having been in practice in Atlanta since 2000, Mary has an extensive expertise in all facets of nursing, especially plastic surgery nursing, Botox, and filler injectables.
Mary received her Bachelor of Science degree in Nursing from the University of South Alabama in Mobile, in 1996. Since her graduation, Mary has completed a number of advanced courses, and holds certification in Basic Life Support and Advanced Cardiac Life Support. Additionally, she is a Registered Nurse First Assistant, and a Certified Nurse, Operating Room. Mary’s expertise lies in Botox and filler injectables, and she has written and published about injectables in the peer reviewed surgical textbook, Eyelid and Periorbital Surgery. With her well-known reputation, Mary has built an established and busy practice in injectables. Furthermore, she has provided training to residents at Emory University’s Plastic Surgery Residency program, and has been an injectable trainer for Allergan, makers of Botox, and Juvederm.
In addition, Mary has extensive experience in plastic surgery itself, as she has been the primary surgical assistant for renowned plastic surgeons at Paces Plastic Surgery. Mary is now the surgical assistant to Dr. Farzad Nahai, a plastic surgeon for the Center for Plastic Surgery at MetroDerm, and helps aid in the management and care for their surgical patients. Mary’s other achievements include developing and organizing a medical mission to Kilimanjaro Christian Medical Center in Moshi, Tanzania, and plans to continue her endeavor with future medical missions. Mary attributes her success to her determination, and being excited by what she can achieve in her career. When she is not working, Mary enjoys traveling, playing golf, and spending time with her family.
Learn more Mary Popp here and read her upcoming publication in Worldwide Leaders In Healthcare.

Background The burden of stroke on health systems in low-income and middle-income countries is increasing. However, high-quality data for modifiable stroke risk factors in sub-Saharan Africa are scarce, with no communitybased, case-control studies previously published. We aimed to identify risk factors for stroke in an incident population from rural and urban Tanzania. Methods Stroke cases from urban Dar-es-Salaam and the rural Hai district were recruited in a wider study of stroke incidence between June 15, 2003, and June 15, 2006. We included cases with first-ever and recurrent stroke. Community-acquired controls recruited from the background census populations of the two study regions were matched with cases for age and sex and were interviewed and assessed. Data relating to medical and social history were recorded and blood samples taken. Findings We included 200 stroke cases (69 from Dar-es-Salaam and 131 from Hai) and 398 controls (138 from Dar-es- Salaam and 260 from Hai). Risk factors were similar at both sites, with previous cardiac event (odds ratio [OR] 7·39, 95% CI 2·42-22·53; p<0·0001), HIV infection (5·61, 2·41-13·09; p<0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49-8·28; p<0·0001), smoking (2·72, 1·49-4·96; p=0·001), and hypertension (2·14, 1·09-4·17; p=0·026) identified as significant independent risk factors for stroke. In Hai, additional risk factors of diabetes (4·04, 1·29-12·64) and low HDL cholesterol (9·84, 4·06-23·84) were also significant. Interpretation We have identified many of the risk factors for stroke already reported for other world regions. HIV status was an independent risk factor for stroke within an antiretroviral-naive population. Clinicians should be aware of the increased risk of stroke in people with HIV, even in the absence of antiretroviral treatment.

Background: To emphasise the value of on-going commitment in Global Health Partnerships. Materials and Methods: A hospital link, by invitation, was set up between United Kingdom and Tanzania since 2002. The project involved annual visits with activities ranging from exchange of skill to training health professionals. Furthermore, the programme attracted teaching and research activities. For continuity, there was electronic communication between visits. Results: Six paediatric surgeons are now fully trained with three further in training in Africa. Paediatric surgery services are now separate from adult services. Seven trainee exchanges have taken place with four awarded fellowships/scholarships. Twenty-three clinical projects have been presented internationally resulting in eight international publications. The programme has attracted other health professionals, especially nursing and engineering. The Tropical Health and Education Trust prize was recently achieved for nursing and radiography. National Health Service has benefited from volunteering staff bringing new cost-effective ideas. A fully funded medical student elective programme has been achieved since 2008. Conclusion: Global Health Partnerships are an excellent initiative in establishing specialist services in countries with limited resources. In the future, this will translate into improved patient care as long as it is sustained and valued by long term commitment.